- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,011.87 / $11,481.54
| Facility | | $1,862.09 | $5,011.87 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,467.37 / $7,079.46
| Professional | | $2,818.38 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,748.98 / $27,542.29
| Facility | | $4,466.84 | $11,748.98 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,981.07 / $7,762.47
| Professional | | $2,570.40 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $7,585.78 / $19,498.45
| Facility | | $398.11 | $7,585.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,786.30 / $9,772.37
| Professional | | $2,884.03 | $4,786.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,890.45 / $7,244.36
| Professional | | $2,630.27 | $3,890.45 | $7,244.36 |